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Screening of Gestational Diabetes and Hypertension Among Antenatal Women in Rural West India

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Screening of Gestational Diabetes and Hypertension Among Antenatal Women in Rural West India Screening of Gestational Diabetes and Hypertension Among Antenatal Women in Rural West India Viral R. Dave1, Bhavik M. Rana1, Kantibhai N. Sonaliya1, Suraj J. Chandwani2, Samkit V. Sharma2, Swati O. Khatri2, Khalid M. Shaikh2, Farida M. Hathiari2 1Community Medicine Department, Gujarat Cancer Society (GCS) Medical College, Ahmedabad, Gujarat, India; 2Gujarat Cancer Society (GCS) Medical College Hospital & Research Centre, Ahmedabad, Gujarat, India Vol. 3, No. 1 (2014) | ISSN 2166-7403 (online) DOI 10.5195/cajgh.2014.140 | http://cajgh.pitt.edu New articles in this journal are licensed under a Creative Commons Attribution 4.0 United States License. This journal is published by theUniversity Library System of the University of Pittsburgh as part of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. DAVE Abstract Background: Hypertension and gestational diabetes are among the leading causes of maternal and perinatal mortality, especially in rural areas of developing countries with meager health facilities. With early diagnosis and timely treatment, these adverse events can be decreased. The primary aim of this study was to implement a screening program for gestational diabetes and hypertension, and to assess risk factors associated with these conditions among antenatal women in the rural area of the Gujarat province in India. Methods: A cross–sectional study was conducted at one of the rural areas of Gujarat province in India. Following a random cluster sampling procedure, the village of Davas was selected. A multistage random sampling method was utilized, resulting in a sample of 346 antenatal women. Screening guidelines from the American Diabetes Association were followed for gestational diabetes screening. Results: The majority of antenatal mothers (55.50%) were between 21-25 years of age. 242 antenatal women were multigravida, and among them, 85.96% had institutional delivery at their last pregnancy. Of the total 346 women, 17.60% were prehypertensive. The prevalence of systolic hypertension was 1.40%, diastolic hypertension was 0.90%, and gestational diabetes was 1.73%. Conclusion: Socioeconomically upper class, a family history of hypertension, and BMI ≥ 25 were strong risk factors for hypertension during pregnancy and gestational diabetes. Health education should be made readily available to antenatal mothers by paramedical workers regarding symptoms of hypertension and gestational diabetes mellitus for early self identification. Keywords: gestational diabetes, hypertension, screening, maternal mortality, perinatal mortality Screening of Gestational Diabetes Research and Hypertension Among Antenatal Women in Rural West India Maternal mortality and perinatal mortality are two very important indicators of the developmental index of a country and have a significant impact on the Viral R. Dave1, Bhavik M. Rana1, population’s life expectancy. Hypertension (HTN) during pregnancy/pre-eclampsia and gestational diabetes Kantibhai N. Sonaliya1, Suraj J. are among the leading causes of maternal and perinatal 2 2 Chandwani , Samkit V. Sharma , morbidity and mortality, especially in rural areas of 2 2 Swati O. Khatri , Khalid M. Shaikh , developing countries.1,2 Farida M. Hathiari2 The literature suggests that 10-15% of maternal 1Community Medicine Department, Gujarat mortality in developing countries is due to hypertensive Cancer Society (GCS) Medical College, disorders of pregnancy.3,4 Various adverse effects of Ahmedabad, Gujarat, India; 2Gujarat Cancer HTN in pregnancy include preterm delivery, intrauterine Society (GCS) Medical College Hospital & growth retardation, reduced birth weight, still birth, and Research Centre, Ahmedabad, Gujarat, perinatal mortality.5,6 Early detection and prompt care are India required to prevent adverse outcomes of pregnancy with HTN. For this reason, it is recommended to evaluate a This work is licensed under a Creative Commons Attribution 4.0 United States License. This journal is published by theUniversity Library System of the University of Pittsburgh as part of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. Central Asian Journal of Global Health Volume 3, No. 1 (2014) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2014.140|http://cajgh.pitt.edu CENTRAL ASIAN JOURNAL OF GLOBAL HEALTH woman’s risk for HTN at their first prenatal visit. In Centre, Ahmedabad, India, the present study was India, the National Health Programme of Reproductive conducted at one of the rural areas of the Gujarat and Child Health has stipulated routine screening of province in India. The study was conducted between blood pressure (BP) for antenatal mothers at each visit, March 2013 and June 2013 and utilized cross-sectional which should be implemented in conjunction with the assessments. A multistage random cluster sampling assessment of maternal history of HTN symptoms. method was utilized to obtain a sample of 346 antenatal women. After preparing a list of districts of Gujarat state Prevalence of gestational diabetes mellitus in their ascending order as per their population, the (GDM) in some ethnic groups ranges from 1 to 14% Banaskantha district was randomly selected. Following depending on screening method selection, diagnostic random selection procedure, the taluka “Deesa” criteria, and population screened. GDM can negatively (administrative subunit of district) and the village of affect pregnancy and result in adverse perinatal outcomes “Davas” were selected. such as macrosomia, birth trauma, shoulder dystocia, and higher rates of Cesarean section.7 In India, screening is The Primary Health Centre (PHC) is a very essential in all pregnant women, as Indian women have basic medical setting, which provides health care services an eleven-fold increased risk8 of developing glucose to rural populations. The PHC of Davas was contacted to intolerance during pregnancy compared to Caucasian ascertain a list of “anganwadi” discovered in the field women,9 which can be decreased with early screening, practice area of PHC. Anganwadi is a part of the Indian diagnosis, and treatment. It is generally accepted that public health-care system where basic health-care women of Asian origin, especially ethnic Indians, are at activities are carried out for antenatal and postnatal a higher risk of developing GDM and subsequently type women, adolescent girls, and children less than 6 years 2 diabetes.10,11 The so-called Asian-Indian phenotype of age. PHC in Davas covers a total population of 39,001 refers to certain unique clinical and biochemical people and 15 other villages around Davas, as per the abnormalities in Indians, which includes, but is not 2011 census. Anganwadi centers are a basic unit of the limited to, increased insulin resistance and greater Integrated Child Development Scheme run by the abdominal adiposity. This phenotype makes Indians government of India and provide health care services to more prone to diabetes.12 antenatal and postnatal women, adolescent girls, and children less than 6 years of age. Monthly prenatal check The objective of this study was to implement ups is one of the key health services provided by these screening for gestational diabetes and HTN and to centers. A total of 346 antenatal women were registered investigate risk factors associated with the development with all anganwadis covered by Davas PHC. All were of these conditions among women in Gujarat province in interviewed and after informed consent was taken from India. The ultimate goal of this work was to minimize each participant, they were included in the study. A complications and reduce morbidity and mortality pretested and structured questionnaire on socio- associated with gestational diabetes and HTN in high- demographic information, obstetric details, and outcome risk groups. of screening tests was used for data collection. Various risk factors generally associated with gestational diabetes Methodology and HTN such as age, BMI (body mass index), education, occupation, socioeconomic class, and family history After obtaining permission from the were also assessed using questionnaires. Institutional Ethical Committee at Gujarat Cancer Society (GCS) Medical College, Hospital & Research This work is licensed under a Creative Commons Attribution 4.0 United States License. This journal is published by theUniversity Library System of the University of Pittsburgh as part of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. Central Asian Journal of Global Health Volume 3, No. 1 (2014) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2014.140|http://cajgh.pitt.edu DAVE The modified Prasad classification13 was used mothers (55.50%) were 21-25 years of age. It is for socioeconomic stratification, which is commonly noteworthy that 21.10% of pregnant women were ≤ 20 used on the Indian subcontinent. This classification years of age while 2.89% of participants were > 30 years system divides the community into five different classes aged. 60.98% of expectant mothers were illiterate, and based on per capita income of family and taking into only 0.87% had education at secondary school level, consideration All India Consumer Price Index declared while none of them had completed any secondary by the Labour Bureau, Government of India at the time education. Most of participant females were housewives of study.14 (63.58%), while 34.97% of mothers were engaged in strenuous labor activities such as farming, construction,
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